- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $8.16 / $26.54
| Facility | | $4.08 | $8.16 | $26.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.60 / $2.72 / $4.00
| Professional | | $2.60 | $2.72 | $4.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $3.37 / $11.04
| Facility | | $2.06 | $3.37 | $11.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.98 / $3.37 / $5.68
| Professional | | $1.98 | $3.37 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.98 / $17.07 / $27.52
| Facility | | $2.98 | $17.07 | $27.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $2.18 / $4.30
| Professional | | $2.18 | $2.18 | $4.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $1.91 / $2.39
| Professional | | $1.74 | $1.91 | $2.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.64 / $3.64 / $3.64
| Facility | | $3.64 | $3.64 | $3.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.80 / $4.80
| Professional | | $1.30 | $1.80 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $2.18 / $2.18
| Professional | | $1.89 | $2.18 | $2.18 |